Hemodynamic forces play an important role in vascular pathology, particularly in relation to the localization of atherosclerotic lesions and plaque structure. Rapid advances in clinical imaging modalities and more sophisticated methods for assessment of blood flow in conjunction with the development of computational fluid dynamics (CFD) offers the possibility to predict and study flow in the vascular system. It is expected that image-based simulation of flow dynamics and progress in CFD technology may be an important and effective tool for biomechanical research on a new research field of atherosclerosis pathophysiology, risk stratification of plaque progression, prediction of in-stent neointimal hyperplasia and degeneration of bypasses. The paper presents basic data describing components of CFD processing and the emerging applications of CFD in cardiology in the example of pulsatile blood flow simulation in the left coronary artery. The plaque distribution and stability are discussed in relation to local wall shear stress.